Closing the Gap - PBS Co-payment Measure

The CTG PBS Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders living with, or at risk of, chronic disease.

The Closing the Gap (CTG) Pharmaceutical Benefits Scheme (PBS) Co-payment Measure improves access to PBS medicines for eligible Aboriginal and Torres Strait Islanders who are living with, or at risk of, chronic disease. Closing the Gap prescriptions attract a lower or nil patient co-payment for PBS medicines.

Patient eligibility

The measure aims to benefit Aboriginal and Torres Strait Islander people of any age who present with an existing chronic disease or are at risk of chronic disease and, in the opinion of the prescriber:

  • would experience setbacks in the prevention or ongoing management of chronic disease if they did not take the prescribed medicine, and
  • are unlikely to adhere to their medicines regimen without assistance through the measure

Eligible patients can be registered at either:

  • general practices participating in the Indigenous Health Incentive under the Practice Incentives Programme or
  • Indigenous Health Services in urban and rural settings

Prescriber eligibility

The following prescribers are eligible to provide their patients with a Closing the Gap annotated script:

  • any medical practitioner working in a practice that is participating in the Indigenous Health Incentive under the Practice Incentives Programme
  • any medical practitioner working in an Indigenous Health Service in rural or urban settings
  • any medical specialist in any practice location provided the patient is eligible under the Closing the Gap - PBS Co-payment Measure, and has been referred by a medical practitioner working in a practice that is participating in the Indigenous Health Incentive PBS Co-payment Measure under the Practice Incentives Programme

Annotating prescriptions

When a patient is registered for the measure and the prescriber wants to grant the benefits of the measure to the patient, the prescriber will annotate the patient’s prescription to indicate that it is to be dispensed with co-payment relief. Closing the Gap prescriptions will either have an automated annotation or a manual annotation.

Under the measure, general (non-concessional) patients who present a Closing the Gap prescription should be charged the current concessional rate for each PBS item on that prescription. Concessional patients who present a Closing the Gap prescription do not need to pay a patient co-payment for each PBS item on that prescription. However, mandatory charges - such as any applicable brand premiums - must still be paid by the patient or their agent.

If a patient presents as an eligible CTG patient but does not have an annotated prescription confirming their eligibility, the pharmacy will need to refer the patient back to their prescriber.

Processing annotated prescriptions

Prescribers must annotate the prescription with the letters 'CTG', their initials and signature.

When you receive a manually annotated prescription and are processing that prescription through your dispensing software, you must ensure that the Closing the Gap code is entered correctly into your processing software either manually or automatically. The correct code to use will depend on your dispensing software.

For example, using a correct Closing the Gap code of H, 00B or CTG00B will make sure the manual annotation is valid. Using an invalid code will result in an incorrect calculation of the payment due from the patient for their prescription.

Claiming

You must include the Closing the Gap annotation on the prescription in the Pharmacy Dispensing System prescription record.

You will be reimbursed the cost of the medicine supplied, inclusive of the co-payment relief amount applicable, if the annotation is valid. If the prescription is a Closing the Gap under co-payment prescription, you will be reimbursed the price of the PBS item minus the applicable patient co-payment.

Helping you reconcile Closing the Gap prescriptions

We will provide additional information in your PBS reconciliation statement. Closing the Gap prescriptions will be clearly identified by the 'CTG' annotation, which will be included in the reconciliation statement information.

More information

Contact us for more information on Closing the Gap - PBS co-payment measure. You can also visit PBS Contacts for Industry from the Department of Health website.

Further information can be found in the pharmacy staff resource booklet available to download from the PBS website.

For information about the COAG National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, visit the Department of Health website.

Page last updated: 5 February 2016

This information was printed Monday 29 August 2016 from humanservices.gov.au/health-professionals/services/medicare/closing-gap-pbs-co-payment-measure It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.